Friday, February 24, 2017

Twenty years ago, when academic researcher Julene Johnson wanted to study how music might help the aging process, she couldn’t get funding. Johnson, a professor at the Institute for Health & Aging at the University of California, San Francisco, suspected that music might improve memory, mood and even physical function.

And, she thought, what could be more perfect than choral music? Your instrument is already in your body, and you are bathed in beautiful sound by fellow music makers. Singing in a group is fun, so there’s plenty of reason to come back week after week: You get to see your friends and exercise your vocal cords and brain all at once.

Fast forward to 2010, when Johnson won a Fulbright scholarship to study the impact of singing in the quality of life of older adults in Finland.

Why Finland?

Because there, children study arts, but they don’t stop when they get older, as so many people do in the United States. They keep singing or making music throughout their lives. In fact, in one city (population 125,000) there were more than 50 choirs — six of which were dedicated to older adults. Because of its emphasis on cradle-to-grave musical expression, Finland seemed the perfect place to study the effect of music on aging.

Music as a Force for Good

In Finland, Johnson saw the effects up close, including how making music together can build group cohesion toward a common goal.

Vocal music even played a pivotal role in Finnish history, Johnson notes. “Music was used as a political force,” she says. When Finland was ruled by Russia, citizens would meet and talk about politics. They planned how to change the future at singing festivals, which eventually led to the country’s independence.

When Johnson returned to the U.S., she was determined to learn more. So when the National Institutes of Health called for proposals to identify novel ways to promote independence and well-being in older adults, she applied for, and receive, a grant founding her Community of Voices study, the largest of its kind.

Johnson hypothesized that music participation is a cost-effective way to promote health, independence and well-being to help an increasingly diverse population of older people remain active and independent. Other studies have found that older adults who sing in choirs tend to have high rates of well-being and mood, but they didn’t address whether those effects can be attributed to choral singing or to the self-selection of the participants. The Community of Voices Study

Johnson’s study — large, rigorous and randomized — would really put the hypothesis to the test. Involving 390 participants from 12 senior centers in the San Francisco Bay area, the Community of Voices study is unique in a few ways.

For starters, it is the first to test the effects of an arts-based intervention for older adults on improving key measures of health and well-being: cognitive health, physical functioning, emotional well-being and social connectedness.

Another difference is the deliberate recruitment of ethnically-diverse older adults. By 2030, nearly half of people over 65 are expected to come from diverse racial and ethnic backgrounds.

After participants were recruited, they were screened and given assessments that would be remeasured at six and 12 months. Participants needed to be 60 or older and have adequate vision and hearing and fluency in English or Spanish. People with significant cognitive impairment were excluded. Of the nearly 400 participants, 55 percent had not sung in a choir as an adult.

Serious About Singing in a Choir

The Community of Voices program also was different from the passive singalong approach to choruses that you might expect to see in senior centers because it was designed to include physical, social and cognitive components as well as performances.

Professional choir conductors and accompanists designed the musical program. Directors made certain adjustments for age, such as changing the key to allow for aging voices to sing without strain. But the 90-minute rehearsals involved learning new songs, paying attention to the conductor and synchronizing personal singing parts with the rest of the choir. The repertoire included Latin, African-American and Filipino music, show tunes that were tailored to each choir.

Rather than sitting the whole time, choir members stood or moved to different parts of the room. A 15-minute warm-up at the beginning of each session included vocal work, breathing and stretching movements. There was also a 10-minute refreshment break.

Measuring Outcomes

Each choir met once a week for a year, and performed three to four times in public. The average age was 71, females represented 76 percent of participants,and two-thirds were non-white. Researchers collected data about falls and the use of health care services every three months, and focused on three primary outcomes:

Cognitive function: Attention and executive function were tested.

Lower body strength: Participants were given a timed sit-to-stand test to assess their ability.

Emotional well-being: Participants were rated on the frequency of depressive symptoms including feeling down, having little interest in things, trouble sleeping, being tired, having poor appetite, feeling bad about themselves, having trouble concentrating or moving slowly.

Participants were also tested for verbal learning and memory, social engagement, social support, loneliness, walking speed, balance and falls. Another key attribute was measured — self-efficacy — which Johnson defined as “people feeling like they have the power to do things for themselves.” In addition to literally building strength to sing louder, Johnson notes that singing can help people find their voice metaphorically speaking.

“The voice is a way of self-expression,” she says. “They can speak up to their landlords.”

The last Community of Voices choir is soon to finish its run for the study, and the data is still being collected and tabulated. One thing is for sure, though: The choirs were a hit. Once they finished participation in the study, all the previous choirs have continued to sing.

Thursday, February 16, 2017

Among the problems: doctors who view depression and anxiety in older adults as 'normal'By Terry Fulmer for Next Avenue

(Next Avenue invited all our 2016 Influencers in Aging to write essays about the one thing they would like to change about aging in America. This is one of the essays.)

Credit: Getty Images

Everyone deserves equal treatment — in the broader society and in our health care system. Today, older people are often not treated fairly and do not get the care they deserve, simply because of their age. While one of our great success stories in the 20th century was the stunning gain in human longevity, recent research from The Frameworks Institute, funded by my group, The John A. Hartford Foundation, and others, has found that the majority of us still don’t recognize ageism or its deleterious effects. They call it a “cognitive hole,” a mental blind spot.

As 10,000 of us turn 65 each day, it is critical that we shine a bright light on this insidious prejudice. It is a matter of simple fairness and justice. It is a way to honor the priceless and irreplaceable contributions that older adults make every day to enrich our society and culture. And for those of us at The John A. Hartford Foundation, it is critical to the broader effort to improve care for older people.

The Dangers of Ageism

Research during the last two decades has implicated ageism in the under- and over-treatment of older patients, as too many clinicians mischaracterize organic medical conditions as normal aging. Others ignore pain, anxiety and depression as unavoidable as we get older or unconsciously view older people as less worthy or less important than their younger counterparts.

A classic example is the under detection of elder mistreatment, when, for example, clinicians ascribe bruises to anticoagulants instead of making an effort to ensure there is no family violence. Another — the assumption that all older people become confused and forgetful, when, instead, a brain tumor may be the real problem.

These negative and inaccurate views of older people consistently hamper our ability to recruit nurses, doctors and other health professionals into geriatrics and gerontology. The result: our health care workforce often lacks the knowledge and experience to treat a group of patients who make up 35 percent of all hospital stays and 27 percent of all doctor’s office visits. And though nearly four in 10 older people take five or more medications, clinical trials generally exclude older patients with multiple chronic conditions, so we may misjudge drugs’ efficacy (and even dangers) with this important patient population.

Even our own views of aging can have important influences on health and well-being. Researchers note people with more positive expectations about aging live longer, experience less stress and have a greater willingness to exercise and eat better. Conversely, negative perceptions of aging — inadvertently supported by unhelpful and negative stereotypes in popular culture and the media — can reinforce self-defeating behaviors that make us more vulnerable to disease and disability.

Developing an Age-Friendly Health System

During the last century, our health care system has consistently demonstrated an impressive ability to adapt and to find innovative solutions to challenging problems. Looking ahead, we need an intensive effort to create an age-friendly health system where all older adults and their families feel that the care they receive is the care they want and that they feel respected in the process.

We need health care suffused with aging expertise, devoted to person- and family-centered care, and able to provide coordinated services in the hospital, clinic and the community. This work is neither simple nor easy. Raising awareness about, and addressing, ageism throughout the health care system — and throughout our society — will be critical to delivering the care all of us want and deserve as we get older.

Friday, February 10, 2017

Volunteers pass out laminated bookmarks with the 10 signs of Alzheimer's at the local supermarketCredit: Courtesy of Paynesville (MN) ACT on Alzheimer's

Can a strong community network help ease the challenges faced by people with dementia and their families? That’s the hope of a national volunteer-driven initiative known as Dementia Friendly America (DFA).

“Our goals are to foster dementia-friendly communities that will enable people who are living with dementia and their care partners to thrive and to be independent as long as possible,” says Olivia Mastry, who’s guiding the effort. “The side benefit is that it’s beginning to normalize [Alzheimer’s], to reduce the stigma. It’s created an environment that’s allowed people to talk about this disease.”

Mastry comes to the issues from personal experience. She and her husband cared for her mother-in-law, who had dementia, the last four years of her life. “That’s given me deep context and understanding of what this takes,” she says, “The caregiver role is so big it can be made easier by an entire community coming together.”A New Initiative

DFA next month will make live a web portal that offers communities a roadmap to create a dementia-friendly environment in many sectors of life, from churches to banks, government agencies and supermarkets.

“From a pure business perspective it makes a lot of sense for us to do this kind of work,” says Frank Fernandez of BlueCross/BlueShield Minnesota (BC/BS Minnesota), which insures many older adults. “Beyond that, the work aligns with our mission, which is to make a healthy difference in people’s lives.”

BC/BS Minnesota, one of 50 organizations on the DFA national council, is offering educational brown bag lunches to its employees and training its customer service representatives to better equip them to talk to people with dementia and their caregivers. It also contributed $750,000 to ACT on Alzheimer’s, a statewide initiative on which DFA is modeled.

Mastry adds that DFA will help communities find local funding to launch such efforts. But even without funding, she stresses, organizing can begin.

“If there is a champion in the community, you can do it,” she says. “Communities can really move this. So we’re trying to encourage them to take that first step.”

Here is a sampling of what communities around the country are doing to become dementia-friendly:

Minnesota’s first dementia-friendly canine

Credit: Courtesy of Paynesville (MN) ACT on Alzheimer's

Rural Challenge: Identify Those Who Need SupportIn 2014, Paynesville, Minn., population 2,400, launched an ambitious multi-pronged effort to reach out to an estimated 200 local people who have dementia. “The most difficult challenge we have is finding the people,” says Linda Musel, co-chair of Paynesville Area ACT on Alzheimer’s.

They began by surveying residents. “We went to every faction we could think of — bankers, lawyers, caretakers, government, teenagers — and we surveyed them,” says Musel. Some 90 people showed up at their first organizing event, a big turnout for a small town. The group decided to focus on educating the public and assisting caregivers.

They offer a class called “Dementia Friends,” which helps people overcome their fears and uncertainty about communicating with folks who have dementia. They also provide classes to emergency medical personnel and firefighters, who requested specialized training.

To reach young people, the group purchases relevant books for school libraries and teaches classes at the high school.

“We were surprised in our survey that the teens said, ‘That’s my grandma. Mom and Dad whisper about this, but they don’t tell us what’s going on.’ They want to help too,” Musel says.

Advocates also faithfully go to the town’s only supermarket on Wednesdays: senior discount day. They assist with shopping to relieve caregivers and pass out literature, including bookmarks with the 10 signs of Alzheimer’s, and let people know how to find support.

For their part, local ministers organized an Alzheimer’s Awareness Sunday. Caregivers often feel their loved one is not welcome at church, Musel says, and part of their educational effort is simply to remind people to smile and be welcoming.

Denver: Entrepreneurs Develop Technology for Connecting

One unusual dementia-friendly initiative is in Denver, Colo., led by Amanda Cavaleri, 27. Denver is one of DFA’s pilot communities, along with Tempe, Ariz.; Santa Clara County, Calif.; Prince George’s County, Md.; Knoxville, Tenn. and the state of West Virginia.

Cavaleri (see her TED Talk), whose expertise is new technology for older adults, has brought together key players who are interested in dementia-friendly efforts: Prime Health, made up of 1,000 health care administrators, physicians, entrepreneurs, investors, technologists and academics; the Colorado Technology Association; Catalyst, a digital health consortium; Jiminy Wicket, which promotes intergenerational croquet for people with dementia and Cavaleri’s nonprofit Connect the Ages, an intergenerational digital storytelling program.

“We wanted to see if there was interest from the entrepreneurial community and there was,” she says, including many who had family experience with dementia. “We chose to focus on the ‘extreme user’ — someone who is home alone, with dementia.”

Such individuals face many challenges, she explains — changes in depth perception, vision and cognition.

“We’re trying to figure out how we can help entrepreneurs so they can partner with home health organizations or communities,” says Cavaleri. “How can they receive funding and help them be successful and lower health care costs and improve quality of life?.”

Cavaleri works to create opportunities for elders, including those with dementia, to tell their stories. “Reminiscing is a really good tool to help people with dementia feel safe emotionally and have more stable behaviors,” she says.

Students meet face to face with people in retirement communities who have dementia, and capture their oral histories. Another pilot project that engages students is the Veterans History Project at the Library of Congress.

Cavaleri hopes DFA will eventually spark monthly coffee shop gatherings where caregivers, people with dementia and students can go to interact with each other, to participate in storytelling and reminiscing.

“We’re able to pass down these older adults’ knowledge and experience,” she says. “For both older and younger, it’s an avenue to systemically reducing isolation and building purpose — and hopefully attract some young talent for the longevity workforce.”

West Virginia – Statewide Pilot

Of DFA’s initial pilot programs, West Virginia is the only statewide initiative. “As I learned more about the work in Minnesota and the experiences with the medical community, it seemed like a natural fit for West Virginia,” says Helen Matheny, with the Blanchette Rockefeller Neurosciences Institute in Morgantown, who is leading the effort.

The initiative builds on partnerships already in place with AARP, the Alzheimer’s Association and other groups related to senior care and healthy lifestyles, she says. Phase one will be to raise awareness statewide and build capacity for doing dementia-friendly work in many sectors. In 2016, they hope to begin implementing programs in local communities.

They also will use social media to connect people with local resources.

“The idea is not to reinvent the wheel,” Matheny says. “We have a lot of resources readily available, so we want to be a convener and help facilitate getting residents to the right resources and tools that they need.”

As a young boy, Tom Lawrence was fascinated with dinosaurs and dreamed of becoming a paleontologist. Life had other things in store.

But now, at 69, Lawrence drives each week to a building marked “Dinosaur Journey” in Fruita, Colo., walks into a laboratory and helps prepare 152-million-year-old dinosaur fossils. He’s been doing it since 2010. “It was a dream come true,” Lawrence says, of his first experiences working at Dinosaur Journey, operated by the Museums of Western Colorado.

Lawrence and a legion of retirees are finding opportunities to get their hands on prehistoric fossils by volunteering for museums across the U.S. and Canada. And they’re greatly appreciated. Since dig sites are rich with specimens, more help is always needed.

“As a small museum, we rely a lot on volunteers to help fill roles that otherwise we wouldn’t have the staff to do. Volunteers are awesome to work with out in the field — without their work we wouldn’t be able to run the operation the way we do,” says Rob Gay, paleontologist and curator of education at the Museums of Western Colorado.

A Major Discovery

Kay Fredette, 78, began volunteering at Dinosaur Journey in 1986. She sought to reconnect with her interest in natural history after her children left for college.

In 2014, one of Fredette’s discoveries made headlines across the globe.

“We were just digging, and I found a lump, and I said out loud, ‘Oh no, another vertebra,’” she says. “We find many, many vertebrae, and some of them are very, very hard to prep because they’re so complex. The [piece] that I thought was the ball of the vertebra dipped down and rose back up again, and there was another lump. We basically had the end of a drumstick. It was the knuckle end — the distal end of a femur.”

The two-meter-long femur, which took four years to dig out, wound up breaking the record for the largest known Apatosaurus femur in existence.

True, dinosaur digging can be physically taxing for someone in her 70s. “Ibuprofen works wonders,” Fredette says. She keeps showing up to chase the bones, donating about 20 hours of her time each week.

“Every time you find a new bone it’s exciting, because it’s the first one that’s ever been seen by human eyes,” Fredette says. “Even if it’s just a fragment, it’s that kind of jigsaw puzzle solving that’s always fun.”

Volunteers are trained on what to look for when preparing fossils and progress to more challenging projects based on their abilities and comfort level, Gay says.

Confident About Digging Up Dinosaurs

Back in the laboratory, volunteer Betsy Leonard, 63, buffs away rock fragments (called matrix) from a fossil specimen using dental tools such as metal picks, wet toothbrushes and a tiny air compressor. She has been volunteering for about two years and says she’s growing confident in her abilities.

“My very first dig, I broke a [dinosaur] bone,” Leonard says. “I was devastated.” The staff members weren’t. Leonard recalls that they said: “Ah, don’t worry about it. Here’s the glue.”

Often, children will nose up to the windows of the laboratory, which face out to the museum. Then, Leonard will look up from her work, slide open the window and ask, “Have any questions?”

How to Get Involved

Several museums around the country have volunteer opportunities for retirees. Digging typically takes place in summer months and fossil specimens are prepared in labs year-round. If you’d like to become a dinosaur digger, contact your local museum or university to see if they could use you or know who you should try.

Search This Blog

About Front Porch

Front Porch is a not-for-profitorganization based in Glendale, Calif., serving individuals and families through full-service retirement, active adult communities, affordable housing and related management and development services. Front Porch retirement communities offer options ranging from independent living to skilled care, including assisted living and memory care. Front Porch holds an A credit rating from FitchRatings and an A- credit rating from Standard & Poor’s.

Founded in 1999, Front Porch embraces a leading-edge approach to enhancing well-being with innovative communities and programs that meet the changing needs of people as they age.